22-326m Resources to Help You with ECM and Community Supports Referrals
Using the processes in this update makes it easier to refer eligible Medi-Cal members
The Department of Health Care Services’ (DHCS’) California Advancing and Innovating Medi-Cal (CalAIM) program addresses social determinants of health and advances health equity. On January 1, 2022, two components within CalAIM, Enhanced Care Management (ECM) and Community Supports (CS), were rolled out.
To support the DHCS CalAIM initiative, we are partnering with local providers and community-based groups who have the skills to render services to our California Health & Wellness Plan (CHWP) Medi-Cal members. See below for resources and guidance that may be helpful to you and your members.
Community Supports (CS) referrals
Use the below resource to connect Medi-Cal members to financial assistance, food pantries, medical care and other no-cost or reduced-cost help:
- Use findhelp: Search for CS program and/or no-cost or low-cost, direct services to support members with social determinants of health (SDOH) needs. The platform makes it easy to use to refer members to CS providers and close the loop on referrals.
Follow the steps below to begin a search.
- Enter a ZIP Code and click search.
- Choose a topic from the top, then select a subtopic. Services vary based on the ZIP Code.
- Select the CS provider or service that best meets the member's needs.
- Use the provider directory: If you identify a member who qualifies for CS, use the provider directory to identify a CS provider to refer the member to, and contact the CS provider based on the directory contact information to provide the member's information.
- CS Authorization Guides: Go to the provider portal > Forms & Tools. CS providers can use these guides to check for member eligibility before submitting authorization for CS services.
Recuperative care referrals
You can follow the above CS referral process for referring members to recuperative care, but because of the information needed to assess qualifications for recuperative care, we recommend using the below referral process to expedite authorization review:
- The hospital confirms if the member is currently an eligible CHWP member.
- The interdisciplinary team (including the review nurse) determines the member qualifies for recuperative care, based on Community Supports Recuperative Care Auth Guide, and advises on the best recuperative care provider for the member, based on capacity and member needs.
- The hospital submits the authorization request for the member to obtain recuperative care services to the Health Plan with the concurrent review updates. The clinical team will review and issue authorization if criteria is met for the member to receive services post discharge.
- The Health Plan notifies the hospital and recuperative care provider with authorization status. After authorization approval is received, the hospital can send the member to a recuperative care provider.
- The recuperative care provider will provide service to the member and bill using the authorization number provided.
Enhanced Care Management (ECM) referrals
If you identify a member who qualifies for ECM and they are not listed in your eligibility file as enrolled in ECM, you can refer them to an ECM provider.
- Submit a referral as an ECM authorization request through the provider portal (preferred).
- Complete an ECM referral form and fax it to 800-743-1655. Optional referral and screening forms are online > Forms & Tools > Enhanced Care Management (ECM).
Find an ECM provider, go to the provider directory.
Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.